Asthma

Diagnosis and Assessment of Disease Table 1. Classifying Asthma Severity and Initiating Treatment in Patients Not Taking Long-term Control Medication – Youth ≥ 12 Years of Age and Adults Components of Severity Symptoms Intermittent Classification of Asthma Severity Persistent Moderate Mild ≤ 2 days/week > 2 days/week, but not daily Daily Night-time awakenings ≤ 2 ×/month 3-4×/month > 1×/week, but not nightly Short-acting β2 -agonist use for symptom control (not prevention of EIB) Interference with normal activity Lung function None > Normal FEV1 between > FEV1 > FEV1 Exacerbations (consider frequency and severity) Recommended step for initiating therapy (Table 3) exacerbations > 80% predicted normal /FVC 0-1/year ≥ 2/year (see notes) Frequency and severity may fluctuate over time for patients in any severity category. Relative annual risk of exacerbations may be related to FEV1 Step 1 Step 2 Step 3 In 2-6 weeks, evaluate level of asthma control that is achieved. Adjust therapy accordingly. EIB, exercise-induced bronchospasm * Normal FEV1 Notes: • The stepwise approach is meant to assist, not replace, the clinical decision-making required to meet individual patient needs. /FVC: 8-19 yr 85% 20-39 yr 80% 40-59 yr 75% 60-80 yr 70% • Level of severity is determined by assessment of both impairment and risk: ▶ Assess impairment domain by patient's/caregiver's recall of previous 2-4 weeks and spirometry. Assign severity to the most severe category in which any feature occurs. . Step 4 or 5 and consider short course of oral systemic corticosteroids ≤ 2 days/week > 2 days/week, but not > 1×/day Minor limitation > FEV1 > FEV1 predicted normal Some limitation > 80% > FEV1 /FVC > FEV1 but < 80% predicted /FVC Extremely limited > 60% > FEV1 > FEV1 reduced 5% predicted < 60% /FVC reduced > 5% Daily Severe Throughout the day Oſten, 7×/week Several times per day • Exacerbation is defined as an acute episode of signs and symptoms requiring oral systemic corticosteroids. ▶ More than two exacerbations/year indicate persistent asthma. ▶ There are no data to correlate frequencies of exacerbations with different severity categories within the classification of persistent asthma. In general, more frequent and intense exacerbations ( eg, requiring urgent, unscheduled care, hospitalization, or ICU admission) indicate greater disease severity. 2 Risk Impairment*

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